Citation Nr: 21076132 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 20-03 112 DATE: December 22, 2021 ORDER Service connection for residuals of a sphenoid mass resection (claimed as sinus condition, surgery) is granted. FINDING OF FACT The Veteran's residuals of a sphenoid mass resection are etiologically related to his nasal symptoms that began during active service. CONCLUSION OF LAW The criteria for service connection for residuals of a sphenoid mass resection are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from November 1956 until his honorable retirement in April 1979. This appeal has been advanced on the Board of Veterans' Appeals' (Board) docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). This case comes before the Board on appeal from a January 2019 decision by a Regional Office of the United States Department of Veterans Affairs (VA). In July 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). Evidentiary Standards In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 12829 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claim. Service Connection VA provides compensation for a disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a "service connection." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to be entitled to service connection there must be competent, credible evidence of (1) a current disability, (2) an in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). When these elements are satisfied, service connection may be granted on a direct basis. Analysis First element: A current disability In December 2018, the Veteran underwent surgery for a chronic disease of his paranasal sinuses, endoscopic septoplasty, to include removal a left sphenoid sinus mass. He asserts this procedure was necessitated by his chronic sinusitis, which is documented in his medical records. According to his surgical records, his post-operative diagnoses include, among other things, a deviated nasal septum, hypertrophic turbinates, and chronic rhinosinusitis. His surgeon documented that he receives post-operative management of his residuals. The Board finds the Veteran has a current disability, residuals of status post sphenoid mass status post resection (claimed as sinus condition, surgery), that can be subject to service connection. Therefore, the first element is satisfied. Second element: An in-service event, injury, or illness, or aggravation thereof The Veteran only asserts that his sinus issues had their onset in service, and they continued throughout his service and after his retirement from military service. This, he asserts, led to his nasal operation and residual conditions. The Board finds one instance of diagnosed nasal symptoms in service. In November 1956, the Veteran received treatment for headaches accompanied by eye issues, which a medical professional diagnosed as "probable sinusitis." There were no other documented sinus symptoms or treatments in service. Nevertheless, the Veteran testified at his July 2021 Board hearing that he only sought treatment one time in service for his nasal symptoms because he refused to wait for any additional treatment when he was able to self-medicate with over-the-counter medications. He testified about the symptoms he had in service and thereafter, and he described his continued self-medication. The Board finds his testimony is credible because he reported similar events to his post-service treating medical professionals. See, e.g., October 2018 VA ENT Consult (Veteran reported "facial pressure between his eyebrows and under his eyes for over 25 years. Has occasional sinus infections."); January 2018 Private Sinusitis Disability Benefits Questionnaire (reporting a "30+ year history of retro-orbital headaches, nasal congestion, and discharge. Numerous antibiotics and nasal sprays did not help."); October 2019 Report for Disability Insurance Purposes of Treatment in a Hospital or from an Attending Physician (chronic sinusitis led to nasal surgery). Despite a lack of continuously documented in-service medical treatment for nasal issues, the Board finds the Veteran's testimony about continuous in-service naval issues is credible and probative. The Board finds the evidence is sufficient to establish an onset of nasal symptoms in service. The second element is satisfied. Third element: A causal link The VA Regional Office did not seek a medical opinion addressing the etiology of the Veteran's nasal symptoms or whether his nasal surgery was necessitated by his in-service nasal symptoms. Nevertheless, the Board finds that the evidence of record is sufficient to establish the necessary causal link. The Veteran submitted a letter, dated January 8, 2020, from Dr. M., the surgeon who performed his nasal surgery in December 2018. Dr. M. stated that the Veteran's chronic disease of his paranal sinuses is "understood to be connected to the chronic sinusitis that he experienced for several decades while in the armed services, and for which he reportedly received treatment over the years prior to coming under [Dr. M.'s] care." Although Dr. M. did not fully explain his rationale, the Board finds there is evidence in the record to support his opinion. In particular, the Veteran submitted Dr. M.'s medical notes documenting his pre- and post-operative care of the Veteran. His notes include a discussion of the Veteran's chronic sinusitis history and the conclusion that his chronic sinusitis and related symptoms led to his nasal surgery. In addition, the Board finds the Veteran's statements and testimony addressing his continuous sinusitis symptoms in-service and following service are credible and probative in this case. He has consistently asserted nasal symptoms in service and following service, which demonstrates chronic nasal symptoms. His medical records likewise document chronic nasal symptoms and his medical providers have consistently referred to his nasal symptoms as chronic. Overall, the Board finds there is sufficient evidence linking the Veteran's nasal surgery to his chronic nasal symptoms that had their onset in service. See Savage v. Gober, 10 Vet. App. 488, 497 (1997) (holding that lay evidence of continuing symptoms of a disability following service can be sufficient to demonstrate a medical nexus between a current disability and an in-service event or injury, even where there is no medical opinion establishing that nexus). Therefore, the third element is satisfied. Accordingly, service connection for residuals of a sphenoid mass resection (claimed as sinus condition, surgery) is granted. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. F. Sawka, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.